It’s hard to ignore what’s changing the complexity of managing patients in the home. Providers are redefining models to create hospital-level care in the home backed by telehealth, evidence-based protocols, integrated teams, and seamless care.

The tides are shifting the expectations of home care. Pressure from reimbursement, shifting payment models, and value-based care are driving the change. Let me share some recent examples with you that will be changing the future of home care.

Highmark Health Enhances Home-Based Acute Care Model

Highmark Health has signed a deal with a solution partner to form a joint venture called Home Recovery Care, LLC. The model provides “essential elements of inpatient care” in a patient’s home. Available to select Highmark, Inc. commercial health plan members in western Pennsylvania and to Medicare Advantage members in 2020, patients can receive home care, infusions, telehealth and durable medical equipment. Patients will receive hospital-quality care in the comfort and convenience of their homes.

As part of this patient-centered, value-based solution, Home Recovery Care patients are monitored for 30 days to ensure they are recovering appropriately, adhering to physician-devised care plans, and attending all necessary follow-up appointments with primary care physicians and other specialists.

“Creating a value-based experience that enables patients and families to heal in the home is a priority for Highmark Health,” said Monique Reese, senior vice president, Home and Community Care for Pittsburgh-based Highmark Health. Through the Home Recovery Care Model, Allegheny Health Network will provide high-quality in-home services such as home care, home infusion, and durable medical equipment,” she said.

Intermountain Healthcare Expanding Intermountain at Home Services

Intermountain Healthcare is expanding its home-based services to include primary care, some traditional hospital-level services, and palliative care for patients with chronic or serious medical conditions.

The new service, called Intermountain at Home, is a comprehensive program that will expand established Intermountain Homecare & Hospice services to prevent or shorten hospital admissions, and enable patients to receive care where they prefer to receive it in their homes.

Home-based nursing services were introduced at Intermountain in 1982 to transition patients safely home after hospital discharges. Since then, Intermountain Homecare & Hospice has continued to grow and now supports patients with home-based post-hospital, palliative, and end-of-life care as well as medical equipment maintenance.

Intermountain at Home will incorporate these services, and add other functions including ongoing home check-ups with a primary care physician or advanced practice clinician. These providers can address their patients’ medical needs and symptoms of chronic or serious medical conditions, without requiring patients to travel to a hospital or clinic.

“Intermountain at Home is a thoughtful, proactive, and preventive healthcare approach that extends complex medical treatment and technologies beyond clinics and hospitals to help us care for patients in their own homes,” said Seth Glickman, MD, Intermountain chief medical officer of community-based care.

Intermountain at Home will also help patients transition directly to new home-based, hospital-level services that will include:

  • remote monitoring
  • expanded telemedicine capabilities
  • virtual urgent care visits through Intermountain Connect Care,  a 24/7 online service that allows patients to receive personalized care from Intermountain caregivers via their smartphones, tablets, and computers
  • appointment-based video visits
  • home caregiver and family support tools
  • dialysis and intravenous medication
  • physical therapy

In addition, this new model will include daily living support through Homespire, an Intermountain company that helps seniors and other people live healthy and independent lives at home.

This support will focus on the social determinants of health, or factors in the places where people live, learn, work, and play that can impact their well-being and quality of life, including finances, education, physical environment, social support, coping skills, healthy behaviors, and access to health services.

“This innovative program is designed around people, supporting first and foremost our patients who are at risk for hospitalization or complications, along with their families,” said Rajesh Shrestha, Intermountain chief operating officer of community-based care. “It will help us keep our patients comfortable and at home, continually connected with caregivers who will monitor their health status through Intermountain’s advanced clinical information systems when we’re not with them.”

The Blue Shield/Landmark Program

Landmark is a comprehensive home-based care program for Blue Shield of California members with five or more specific chronic illnesses has been widely embraced in its first 12 months. The program uses data-driven algorithms to identify members qualified to receive community-based, physician-led care in plan members’ homes so they can better manage multiple complex health issues such as kidney and heart diseases, diabetes, hypertension, and depression.

More than 3,500 members have enrolled in the program since it launched a year ago. Those members used Landmark’s 24/7 access to care, and received more than 15,000 home visits for medical, behavioral, and social support services as well as urgent and post-discharge care.

The Landmark service is available at no additional cost for eligible members of Blue Shield of California and its subsidiary Blue Shield of California Promise Health Plan. Landmark medical professionals do not replace a member’s primary care physician or specialists; they work collaboratively with members’ physicians to reinforce the doctor’s in-office care plan.

How The Program Works

Blue Shield uses data-driven algorithms to identify members who qualify for the Landmark program, then invites them to enroll through letters and phone calls. Primary care physicians of eligible members are also notified about the program.

Key Findings in the Program’s First Year

  • 92 percent of the participating members are enrolled in a Medicare, MediCal or Cal MediConnect plan offered by Blue Shield or Blue Shield Promise; the rest are Blue Shield’s commercial health plan members
  • Average age of program participant is 72

Top 10 Chronic Conditions Addressed

Blue Shield’s Landmark program is currently available in the following counties: Los Angeles, Orange, Sacramento, San Diego, Riverside, San Bernardino, San Mateo, San Francisco and Santa Clara.About LandmarkLandmark Health and its affiliated medical groups (Landmark) partner with health plans and delivery systems to bring patient-centric, in-home care to complex and chronically ill populations. Landmark Health and its affiliated Landmark medical groups (Landmark) partner with care delivery systems, including health plans, to bring additional care to high-need patients. Patients qualify for the Landmark program based on their current health state, number of chronic conditions and complex health needs.The company bears risk for more than 90,000 lives across 13 states. Landmark is available 24/7 to patients and their families. Its value-based model relies on fully-employed, local multidisciplinary care teams to help drive long-term outcomes for patients by bringing medical, behavioral, social and palliative care to individuals, where they reside and when they need it.Remington Takeaways

  • Expect Higher acuity patients. Reimbursement pressures from payers, ACOs, health systems and physicians are creating the need for new models in the home to support higher acuity patient management.
  • Defend your market share. We are seeing some new models with integrates team members that can bypass traditional home care companies because new competition have a team of their own.
  • Redefine. These models are just the tipping point of what is to come. In 2020, there will be much more rapid movement into shared-risk contracting, and value-based contracting. Reassess your current models of care. Change is here.
Disease% of Participating Members
Hypertension99%
Chronic kidney disease76%
Diabetes69%
Peripheral vascular disease66%
Coronary heart disease65%
Pulmonary disease62%
Depression55%
Heart failure53%
Atrial fibrillation37%
Cerebral vascular disease27%

Blue Shield’s Landmark program is currently available in the following counties: Los Angeles, Orange, Sacramento, San Diego, Riverside, San Bernardino, San Mateo, San Francisco and Santa Clara.

About Landmark

Landmark Health and its affiliated medical groups (Landmark) partner with health plans and delivery systems to bring patient-centric, in-home care to complex and chronically ill populations. Landmark Health and its affiliated Landmark medical groups (Landmark) partner with care delivery systems, including health plans, to bring additional care to high-need patients. Patients qualify for the Landmark program based on their current health state, number of chronic conditions and complex health needs.

The company bears risk for more than 90,000 lives across 13 states. Landmark is available 24/7 to patients and their families. Its value-based model relies on fully-employed, local multidisciplinary care teams to help drive long-term outcomes for patients by bringing medical, behavioral, social and palliative care to individuals, where they reside and when they need it.

Remington Takeaways

  1. Expect Higher acuity patients. Reimbursement pressures from payers, ACOs, health systems and physicians are creating the need for new models in the home to support higher acuity patient management.
  2. Defend your market share. We are seeing some new models with integrates team members that can bypass traditional home care companies because new competition have a team of their own.
  3. Redefine. These models are just the tipping point of what is to come. In 2020, there will be much more rapid movement into shared-risk contracting, and value-based contracting. Reassess your current models of care. Change is here.